Table 8.

Interpretive FE

Mental health (MH) QUERI

Implementation goal: an antipsychotic treatment improvement program (ATIP) was designed to implement an evidence-based treatment model for patients with schizophrenia. A second program, TIDES/WAVES, was designed to improve care for patients with depression.

FE activity: for both projects a series of formative evaluations continuously assessed the extent and nature of facilitation by the research team, intervention activities conducted by site personnel, and related barriers and facilitators.

Value:

i. In the ATIP project, FE demonstrated a correlation between the amount of external facilitation and improvement in antipsychotic dosing, the extent to which lack of clinician time inhibits dissemination and QI activities, and the acceptability and utility of MH QUERI tools/products.

ii. In the depression project, FE has generated information about factors influencing caseload capacity for nurse “care managers” who maintain regular contact with depressed patients to monitor treatment adherence, assess symptomatic improvement, provide patient education, and facilitate communication among patients, primary care clinicians, and mental health specialists.

Substance use disorder QUERI

Implementation goal: the opioid agonist therapy effectiveness initiative was designed to implement evidence-based treatment for patients with opioid dependence.50,51

FE activity: during the project, the research team took notes on all facilitation-related telephone calls. They also collected monthly, semi-structured interview data from program leaders. As the project moved forward, it was clear that some sites were very successful in applying the treatment plan while others stagnated.

Value: while the FE provided some suggestions about how to modify the intervention and tools, the data were also useful to accurately “tell the story” of the individual clinics and to illustrate differences between clinics that were successful with implementation versus those that were not.

QUERI, quality enhancement research initiative; FE, formative evaluation; QI, quality improvement; NH, mental health; ATIP, antipsychotic treatment improvement program.